Vitamin A and Stargardt Disease

Yes, You Can Have Stargardt Disease and Still Eat Vegetables!

If you have Stargardt, and you’re trying to educate yourself about this challenging eye problem, then you’ve probably come across the question of what type and how much vitamin A should someone with Stargardt use.

And you’re certainly confused.

I won’t promise to remove all of your confusion, since there are still too many unanswered questions. The science on this is very incomplete.

But I will address some of the more inaccurate information I have heard, and make some basic recommendations of what is needed and what is safe based on over 20 years of personal experience, and almost 40 years of experience from Grace Halloran, PhD.

The focus of this article will be on these four issues:

Do people with Stargardt need any vitamin A and if so how much and in what form?

What is the relationship between the ABCR gene and Stargardt and vitamin A?

What do the people in Integrative Medicine who are treating Stargardt think about this issue?

What advances might come from current research on this topic?

Do people with Stargardt need any vitamin A and if so how much and in what form?

Vitamin A is the raw material that the body needs to make 11-cis retinal which is the light-sensitive pigment made in the retina that allows us to see. The retina of the eye is the most metabolically active tissue in the body, with huge needs for blood flow and resources.

There are millions of chemical reactions per second in the eye when it is exposed to light. The body does its best to conserve and recycle retinal, but there is a high turnover, and a constant need to replenish 11-cis retinal.

So yes, everyone, including people with Stargardt need vitamin A in their diet to maintain the production of 11-cis retinal. No vitamin A, no vision.

How much vitamin A and in what form?

People in Grace Halloran’s Visual Healing Program and the people in the Better Eye Health Program take 5000 IU of vitamin A each day in the form of vitamin A palmitate. We put no restrictions on their consumption of foods containing vitamin A and beta-carotene. For 40 years, people in these programs doing a mix of therapies including microcurrent stimulation, color therapy, eye health exercises, Acu-Eye Point therapy, stress management and supplements see real improvements in their vision. Not everyone, but almost 90% of those who are doing the full program.

What is the relationship between the ABCR gene and Stargardt and vitamin A?

(The genetic abnormality found in many people with Stargardt disease is on a gene that codes for a molecule called “ATP binding cassette transporter” or ABCR. The newer designation for this particular molecule is ABCA4)
Here’s the simple (and incorrect) version of the story:

A relationship has been noted between abnormalities on the ABCR gene and a person having Stargardt disease. There are abnormalities that exist on the ABCR gene that also lead to an improper handling of vitamin A I the body. Debris from the improper processing of vitamin A can be found in some (but not all) people with Stargardt.

Therefore, people with Stargardt should not take any vitamin A, and should avoid all vegetables.

But here’s where this thinking falls apart, leading to a lot of bad advice:

Not everyone with Stargardt disease has an ABCR abnormality. They have a genetic defect, but on a number of different genes.

People with Stargardt do have an ABCR abnormality do not all have a problem with processing vitamin A.

There are a significant number of people with abnormalities on the ABCR gene were not showing evidence of either an eye disease or a problem with vitamin A. Your genes are not your destiny. (Please see the post on Epigenetics.)

Finally, two people can have the same defect on the ABCR gene, but one will express eye disease that looks like Stargardt, and the other will have an eye disease that looks like macular degeneration, or retinitis pigmentosa. (Please see the article on ophthalmologist divide, genetics unite.) Unfortunately, very little in the relationship between genetic defects and the predisposition to disease is clear-cut.

For us, the outcomes we see for the most compelling evidence. 90% of people with Stargardt to do the full Better Eye Health Program see improvements in the health of their eyes that result in a slowing of the deterioration and even repair and regeneration the vision. These improvements occur while using a supplement program that includes 5000 units per day of vitamin A palmitate, and recommendations for a diet high in vegetables and low sugar fruits.

What do the people in Integrative Medicine who are treating Stargardt think about this issue?

Some of the craziest advice that doctors give regarding nutrition occurs when they think about diet and nutrition from the standpoint of “Nutritionism”. “Nutritionism” is a term popularized by the author Michael Pollan. He uses the term to describe the way that doctors and scientist tend to think about nutrition in terms of the sum of many small parts rather than the total picture of everything we put in our body. For this discussion, vitamin A is an essential nutrient for all human beings. To think that you could tell people not to use it and to eliminate vegetables from their diet is on its face ridiculous advice. Yet I have heard this advice given.

What advances might come from current research on this topic?

There is some good news about this subject coming out of the research labs. There are indeed people with Stargardt disease who have evidence of a buildup of oxidized carotenoids in the retina. These occur in everyone but if you have a genetic defect in processing vitamin A the buildup of these materials called lipofuscin can be greater than normal and can be harmful. Researchers are working on synthetic substances that would serve as a raw material to make 11-cis retinal but that would not lead to a buildup of lipofuscin. Some of the earlier versions that have been developed in this type of research have proven quite toxic to the liver. They are also extremely expensive to produce and unstable. Still, keep your ears open for further developments from this branch of research.

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About the author

Damon Miller

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Copyright 2018 by Damon Miller II, MD

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